Most Closely Matched 3rd Party Rapidly Generated LMP, BARF1 And EBNA1 Specific CTL, EBV-Positive Lymphoma (MABEL)

A healthy donor has given blood to make LMP/BARF1/EBNA-1 MABEL CTLs in the lab. We made the
cells by first growing a special type of cells called activated T cells to stimulate the T
cells. We then added specially produced mixtures of proteins that include the LMP, EBNA1 and
BARF proteins. These were used to stimulate T cells. As the T cells grew, we added some of
the healthy donor cells expressing these proteins to stimulate them. We also added a cell
called K562 that has had new genes put inside it so it expresses proteins that stimulate the
immune system to encourage the T cells to grow. K562 cells are cancer cells that have been
treated with radiation so they cannot grow. This stimulation trains the MABEL CTLs to kill
cells with EBV proteins on their surface. These cells were grown and frozen.

For the subject's treatment, the MABEL CTLs will be thawed and infused into the subject over
1-10 minutes. Initially, two doses of MABEL CTLs will be given two weeks apart. Subjects may
be eligible to receive additional doses of the MABEL CTLs up to 6 times.

All of the treatments will be given by the Center for Cell and Gene Therapy at Texas
Children's Hospital or Houston Methodist Hospital.

Medical tests before treatment:

Before being treated, the subject will receive a series of standard medical tests:

Physical exam; Blood tests to measure blood cells, kidney and liver function; Tumor
measurements by routine imaging studies: Computer Tomogram (CT), Magnetic Resonance Imaging
(MRI), or Positron Emission Tomography (PET/CT); Pregnancy test for females who are able to
have children.

Several studies suggest that the infused T cells need room to be able to proliferate and
accomplish their functions and that this may not happen if there are too many other T cells
in circulation. Because of that, if the patient's level of circulating T cells is relatively
high, s/he may require treatment with cyclophosphamide (Cytoxan) and fludarabine before s/he
receives MABEL CTLs.

Medical tests during and after treatment:

Blood tests to measure blood cells, kidney and liver function; Imaging study 8 weeks after
the 1st CTL infusion. If the subject receives additional doses they will also have an imaging
study at 1 to 3 months after their final dose.

Subjects will either be seen in the clinic or will be contacted by research staff yearly for
5 years.

Inclusion Criteria:

SCREENING

1. Any patient regardless of age or sex, with diagnosis of either:

- EBV positive Hodgkin's lymphoma

- EBV Positive non-Hodgkin's Lymphoma (regardless of histologic subtype)

- EBV (associated)-T/NK-lymphoproliferative disease, or

- Severe Chronic Active EBV (CAEBV) - CAEBV is defined as patients with high EBV
viral load in plasma or PBMC (>4000 genomes per ug PBMC DNA) and/or biopsy tissue
positive for EBV

AND

- in first or subsequent relapse (Group A)

- with active disease persisting despite therapy (Group B)

- with active disease if immunosuppressive chemotherapy is contraindicated e.g.
patients who develop Hodgkin disease after solid organ transplantation or if the
lymphoma is a second malignancy e.g. a Richter's transformation of CLL. (Group C)

2. EBV positive tumor

3. Weighs at least 12kg

4. Informed consent (and assent as applicable) obtained from patient/guardian.

TREATMENT

1. Any patient regardless of age or sex, with diagnosis of either:

- EBV positive Hodgkin's lymphoma

- EBV Positive non-Hodgkin's Lymphoma (regardless of histologic subtype)

- EBV (associated)-T/NK-lymphoproliferative disease, or

- Severe Chronic Active EBV (CAEBV) - CAEBV is defined as patients with high EBV
viral load in plasma or PBMC (>4000 genomes per ug PBMC DNA) and/or biopsy tissue
positive for EBV

AND

- in first or subsequent relapse (Group A)

- with active disease persist despite therapy (Group B)

- with active disease if immunosuppressive chemotherapy is contraindicated e.g.
patients who develop Hodgkin disease after solid organ transplantation or if the
lymphoma is a second malignancy e.g. a Richter's transformation of CLL. (Group C)

2. EBV positive tumor

3. Patients with life expectancy greater than or equal to 6 weeks.

4. Patients with bilirubin less than or equal to 3x upper limit of normal

5. AST less than or equal to 5x upper limit of normal

6. Hgb ≥ 7.0 (may be a transfused value).

7. Patients with a creatinine less than or equal to 2x upper limit of normal for age

8. Pulse oximetry of > 90% on room air

9. Patients should have been off other investigational therapy for 30 days prior to
infusion.

10. Patients with a Karnofsky/Lansky score of more than or equal to 50.

11. Sexually active patients must be willing to utilize one of the more effective birth
control methods during the study and for 6 months after the study is concluded. The
male partner should use a condom.

12. Informed consent (and assent as applicable) obtained from patient/guardian.

Exclusion Criteria:

TREATMENT

1. Pregnant or lactating

2. Severe intercurrent infection.

3. Current use of systemic corticosteroids more than 0.5 mg/kg/day

4. Patients receiving ATG, Campath, or other immunosuppressive T cell monoclonal
antibodies within 30 days.